[Question #7065] HPV/Warts

61 months ago

First, thank you for this service and accurate information!!!! I have a question concerning Hpv/warts. I have never had a positive HPV test. Most recent one was a couple weeks ago. I did however several years ago (16 yrs) have what I thought could have GW. I didn’t go and have areas checked out. I did have regular annual exams and nothing was said about warts. I was sexual active with one partner and he ended up getting them. I’m assuming it was GW. They almost looked like tiny skin tags on him, but he never had them before. The ones I had were located at vaginal opening. They eventually went away. (His too) and have never returned. We recently ended our marriage. I am now starting a new relationship. We have had sex once with condom. My concern/ question is after all this time of having no issues could I still pass this to him? Also, after our divorce i went and had std screening everything negative. I had a hsv 1/2 done on my own. I am Hsv 1 positive. I did have a weird breakout once and never again. If this was a ghsv 1 outbreak is this something I should be worried about passing? I thought i had done my research and felt neither I needed to disclose, but now I’m starting to be more concerned as I’m entering a new sexual relationship after 16 years. I appreciate your guidance in this matter.

H. Hunter Handsfield, MD

61 months ago

Welcome and thanks for your confidence in our services. Sorry for the longer than usual delay in this response.

You may not have had a positive HPV test, but almost certainly you have had HPV. The virus is acquired by almost all sexually active people by the time they have had 2-3 sex partenrs; getting genital HPV is a normal, expected, and pretty much unavoidable consequence of sex, except for the small minority who mutually have sex only with each other for life, with no prior partners. The standard HIV tests, done in conjunction with pap smears, miss many infections: a positive result is reliable, but a negative result can miss active infection. In addition, when HPV is present, it is only intermittently detectable.

I really can't comment on the warts vs skin tags issue, i.e. whether or not you and your partner had warts based on self examination. But if you have no active, obvious warts at this time, you can safely assume you don't have a transmissible HPV infection with a wart-causing type of the virus.

Anyone entering a new relationship is potentially at risk of a new HPV infection. However, the large majority of infections remain asymptoamtic and never cause complications or visible problems. You can safely assume your prospective new partner has had genital HPV and could still have an active infection. But the same is true of you and theoretical risks to him. But all things considered, there is no reason to suppose any special risk for either of you. Of course continue with pap smears on a regular basis (your doctor can advise about frequency for routine paps based on your age). You could also consider HPV immunization, which would protect you againsta infection with the 9 HPV types that cause ~90% of warts and cancers, although thie suitability of vaccination depends largely on your and your partner's age. The $500+ cost likely would not be covered by insurance if you're over 40. Again, something to discuss with your doctor.

As for HSV, most positive blood tests for HSV1 are the result of oral infection, usually in childhood, with or without symptoms (oral herpes, i.e. cold sores). Howeve, it could reflect a past genital infection. You don't say enough about your past "weird outbreak" for me to judge the likelihood it was herpes. Feel free to describe it in more detail in a follow-up comment. However, even if it was herpes due to HSV1, it is quite typical to have only the initial episode and no recurrence; and genital to genital HSV1 transmission is rare. (I have never had a patient with genital HSV1 who acquired it by intercourse. Every case was acquired by oral sex.) So even if your HSV1 infection was genital, the chance of transmission to your prospective partner is very low. In addition, there's a 50:50 chance he also has had HSV1, in which case he is immune to a new infection. For all these reasons, this isn't something to worry about or that should have any signficant influence on sexual decisions or relationships going forward.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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61 months ago

These comments are very helpful! I got anxious thinking “what if” I give someone an std. As far as the hsv 1 I had what I thought was a possible yeast infection. I was swollen and sore. My mom gave me a “cream” to apply and I thought it made it worse. I treated it as a yeast infection. It healed in about a week. I know my husband got fever blisters but i don’t ever recall having a fever blister orally. After doing some research I’m not very concerned about the hsv 1. If I’m understanding correctly, then I’m less likely to pass it genital than oral anyway. So I’m going to not dwell on this and move on. Unless you think otherwise!As far as the GW I have not had any type of GW to my knowledge since the incident years ago. (If that is even what it was) I do periodically check to make sure things look normal. I think my confusion came from all the “internet” articles. My concern was although I didn’t have any visible warts i could still pass the virus. If you think this is something I should no longer be concerned with I am moving forward.

Again, thank you for trustworthy And current info!

H. Hunter Handsfield, MD

61 months ago

Thanks for the follow-up information. That event certainly could have been herpes and not yeast. Since your husband has oral herpes (which is always due to HSV1), you could well have acquired it genitally, assuming cunnilingus was among your sexual practices when you were together. But you are correct in your understanding of my previous comments: people with genital HSV1 often have rare or no recurrent outbreaks. They also have infrequent asymptomatic shedding of the virus, i.e. are rarely infectious in absense of symptoms. (Both these characteristics are the opposite of HSV2, which causes frequent outbreaks and frequent transmission in absence of symptoms.) Finally, as I said above, since half of all people in the US have positive HSV1 blood tests, there's a good chance your prospective/new partner already has had it and is immune to catching it again.

Look around at your friends, coworkers, and other adults you know. Almost all of them have had genital HPV, and up to half have it detectable and transmissible right now. All of them could potentially transmit it to their partners. Your situation is no different. In other words, your fear that "I could still pass the virus" applies to almost everyone at one time or another and 30-50% of people at any point in time. It's just part of life and nothing to obsess or worry about!

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